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Acute Traumatic Compartment Syndrome of the Leg in Children: Diagnosis and Outcome
John M. Flynn, MD1; Ravi K. Bashyal, MD2; Meira Yeger-McKeever, MD3; Matthew R. Garner, MD4; Franck Launay, MD5; Paul D. Sponseller, MD, MBA6
1 Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Richard D. Wood Center, 2nd Floor, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399. E-mail address: FLYNNj@email.chop.edu
2 Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRJ 1125, Boston, MA 02114
3 Department of Orthopaedic Surgery, Union Memorial Hospital, Johnston Professional Building, Suite 400, 3333 North Calvert Street, Baltimore, MD 21218
4 Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
5 Service de chirurgie infantile et orthopédique, Hôpital Timone-Enfants, 264 rue Saint-Pierre, 13385 Marseille CEDEX 5, France
6 Division of Pediatric Orthopaedics, Johns Hopkins Hospital, 601 North Caroline Street, Suite 5212, Baltimore, MD 21287
View Disclosures and Other Information

Investigation performed at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, and the Johns Hopkins Hospital, Baltimore, Maryland



Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Biomet Spine, Globus, DePuy Spine).

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 18;93(10):937-941. doi: 10.2106/JBJS.J.00285
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Abstract

Background: 

Currently, the most common clinical scenario for compartment syndrome in children is acute traumatic compartment syndrome of the leg. We studied the cause, diagnosis, treatment, and outcome of acute traumatic compartment syndrome of the leg in children.

Methods: 

Forty-three cases of acute traumatic compartment syndrome of the leg in forty-two skeletally immature patients were collected from two large pediatric trauma centers over a seventeen-year period. All children with acute traumatic compartment syndrome underwent fasciotomy. The mechanism of injury, date and time of injury, time to diagnosis, compartment pressures, time to fasciotomy, and outcome at the time of the latest follow-up were recorded.

Results: 

Thirty-five (83%) of the forty-two patients were injured in a motor-vehicle accident and sustained tibial and fibular fractures. The average time from injury to fasciotomy was 20.5 hours (range, 3.9 to 118 hours). In general, the functional outcome was excellent at the time of the latest follow-up. No cases of infection were noted when fasciotomy was performed long after the injury. At the time of the latest follow-up, forty-one (95%) of forty-three cases were associated with no sequelae (such as pain, loss of function, or decreased sensation). The two patients who lost function had fasciotomy 82.5 and eighty-six hours after the injury.

Conclusions: 

Despite a long period from injury to fasciotomy, most children who are managed for acute traumatic compartment syndrome of the leg have an excellent outcome. This delay may occur because acute traumatic compartment syndrome manifests itself more slowly in children or because the diagnosis is harder to establish in this age group. The results of the present study should raise awareness of late presentation and the importance of vigilance for developing compartment syndrome in the early days after injury. Fasciotomy during the acute swelling phase, even long after injury, produced excellent results with no cases of infection.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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